Rheumatic Diseases in Children: Disease Patterns

[Guest guest]

Disease Patterns

http://home.t-online.de/home/rheuma-kinderklinik/rke-e002.htm

Many people think of " rheumatism " still as being a disease of adults or

seniors. That is not the case: For one thing, rheumatism is not a single

disease but a collective term for many different illnesses. In the other

hand unfortunately also children and adolescents contract the disease.

Besides there are a few rheumatic diseases which occur almost only in

children. The rheumatic diseases have in common that the immune system

does not work properly and begins to attack not only foreign matters

(e.g. viruses or bacteria) but also body's own tissue. Joint

inflammations can thus arise. Also impairments in tendons, muscles,

blood vessels and other organs can develop.

Below we shall give a short survey about the most important rheumatic

diseases of childhood and adolescence.

1. Transient synovitis of the hip (itis fugax)

The most frequent joint inflammation in children is called transient

synovitis of the hip. This inflammation of the hip joint involves

chiefly children between the 3rd and 10th year of life. They suddenly

start to limp, refuse to walk, and complain of pains. Transient

synovitis of the hip is generally painful, but resolves completely

without any lasting sequelae in most cases. But often at onset it is

difficult to isolate it from other partly severe diseases of the hip.

Therefore various examinations may be required before a certain

diagnosis can be set.

2. Reactive Arthritis

Many joint inflammations develop as a reaction of the body's own defense

mechanisms to previous infections with bacteria or viruses. Quite

frequently they may be observed after gastrointestinal infections with

diarrhea. They are named postinfectious or reactive arthritis or

sometimes acute rheumatism. Often swellings and warming of one or more

joints are seen. These illnesses can have a lengthy course and be quite

painful. Young children often report no pain at all. At a close look one

can sometimes observe in the beginning a change in movement or gait. In

most cases postinfectious arthritis heals completely and leaves no

permanent injuries in the joints.

3. Lyme-Arthritis

The Lyme-arthritis or borrelia induced arthritis is a special form of

joint inflammation. Lyme is the name of the place in Connecticut, USA,

where this type of arthritis has been first described. Borrelia are

bacteria transmitted by tick-bites and can cause various diseases, among

others also this joint inflammation. Here we often see pointed swellings

of single joints, quite often of the knee or ankles. In the blood and in

the joint fluid of the children and adolescents concerned various

antibodies against borrelia can be found. This identification is

important because borrelia-arthritis can effectively be treated with

antibiotics. There are, however, also cases in which the arthritis takes

a protracted course despite of sufficient antibiotic treatment. Then

there is the danger of lasting damage to the joints involved.

4. Juvenile chronic arthritis

The term juvenile chronic arthritis (JCA) refers to a group of joint

inflammations which are also called chronic rheumatism. Little is yet

known about its origin. But it seems certain that several factors are

involved in the development of these diseases. Hereditary

predispositions as well as previous infections, accidents (traumata),

and excessive stress may be of importance for the manifestation of JCA.

But often the disease starts without any known previous illnesses.

JCA lasts longer than the other forms of arthritis mentioned above. A

special danger of JCA consists of the fact that the inflammatory process

can impair the joints permanently if one does not succeed in halting it

as early as possible. This can result in lesions of the articular

cartilage and malpositions of the joints.

JCA is usually classified into various subgroups:

4.1 Systemic Juvenile Chronic Arthritis

The systemic juvenile chronic arthritis (SJCA) concerns about 10% of the

children with chronic arthritis. Often the onset is already in infant

age. High fever is apparent in the beginning, recurring over several

weeks, especially in the morning and afternoon, and does not respond to

antibiotics. A rash is partly seen, especially during the febrile

phases. Enlargement of liver and spleen is possible. Every 3rd to 4th

child incurs a pericarditis. An inflammation of the pleura and

peritoneum can join the condition.

At onset of disease fever as well as muscle and joint pain are often in

the fore without joint swellings. Later on these conditions mostly

retreat and an arthritis develops. In some children the arthritis

remains limited to few joints, often, however, are many large and small

joints involved.

4.2 Early Onset Oligoarthritis (Type I)

This form of JCA is also called " young girls' type " because it concerns

about 70-80% girls and only about 20-30% boys. Disease onset is usually

between the first and sixth year of life. As a rule only a few (up to 8

maximally) joints are affected. Knee joints and ankles are mostly

involved, but inflammation may also be found at elbow, hand and finger,

or toe joints. The distribution is mainly asymmetric, i.e. the joints

are not equally strong involved on both sides of the body.

An essential danger of the oligoarthritis type I is the chronic uveitis.

This is a matter of an eye inflammation causing no discomfort in the

beginning, however producing grave eye injuries if undetected. Therefore

especially patients with oligoarthritis type I must see the

ophthalmologist regularly!

4.3 Juvenile Polyarthritis

Polyarthritis means that there is an inflammation (arthritis) of many

(poly) joints. At least there are five joints affected, in most

patients, however, eight to ten or even more. While the pattern in

oligoarthritis is asymmetric, it is mostly symmetric in polyarthritis:

The joints of the body's right and left side are equally afflicted.

There may be an arthritis in large joints like shoulders, hips, or knees

as well as small ones like finger- or toe-joints. Often there is not

only an inflammation of the joints but of the tendon sheaths too.

Onset of disease can be at any age and concerns girls slightly more

often than boys. It means a considerable handicap for the children as

due to the disease they are greatly hampered in their natural urge for

motion.

The juvenile polyarthritis is also named seronegative polyarthritis as

the rheumatoid factor is not present in the serum.

4.4 Chronic Polyarthritis of the Adult Type

In contrast to the juvenile polyarthritis can the rheumatoid factor in

the adult type be identified. Therefore it is called seropositive

polyarthritis. It affects mostly girls from the 11th year of life on and

presents similar to the seronegative polyarthritis. However, the

finger-end joints are often spared. Beside the arthritis inflammations

of the blood vessels (vasculitis) can also develop.

Since the seropositive polyarthritis can progress rather fast and

produce damage on the joints if untreated, it is important to recognize

it early and treat it correctly.

4.5 Oligoarthritis Type II ( " Big Boys' Type " )

As the name " big boys' type " says mostly boys from school age on are

confronted with this form of arthritis. As in the oligoarthritis type I

mainly large joints are affected, the distribution pattern is asymmetric.

Mostly involved are knee- and ankle-joints, but also the hip joints or

joints of the upper extremity. Typical for the disease pattern is an

inflammation of the tendon appendages, so e.g. in the area of the heel,

beneath the patella or on the crista iliaca.

Also in the oligoarthritis type II eye inflammations can occur. This

acute uveitis presents itself, however, with pain, reddening and

shunning of light, so that it cannot be overlooked. With proper

treatment it heals quickly and resolves without any consequences.

If in addition an inflammation of the sacroiliacal joints develops one

does not speak of oligoarthritis type II but of juvenile spondarthritis.

From this at later age a Morbus Bechterew may turn up. If this happens

it might be after about the 20th year of life.

4.6 Psoriasis Arthritis

Psoriasis is a chronic skin disease. About one third of the patients

develop joint problems, many of them arthritis. While in adults usually

the skin symptoms appear first and the arthritis follows, we see in

children often the arthritis before distinct skin lesions lead to the

diagnosis psoriasis.

The psoriasis arthritis mostly proceeds like oligoarthritis and rather

benign, but can also spread to many joints. Typical is the involvement

of single fingers and toes.

4.7 Others

Chronic arthritis is also observed in inflammatory bowel disease like

Morbus Crohn and colitis ulcerosa. Inflammatory diseases of the

connective tissue may also be accompanied by arthritis.

5. Rheumatic Fever

Before antibiotic treatment was established, rheumatic fever was a quite

common disease. Nowadays it is hardly ever seen. Rheumatic fever follows

an infection with certain bacteria (streptococcus). It causes

inflammations in the joints and of the heart. In order to prevent

lasting heart injuries effectively an antibiotic treatment is indispensable.

Lately a rising number of patients with rheumatic fever was reported

from the USA. This statement, however, is not secured. In Western Europe

such observations have not been made.

[Guest guest]

Also some good info - seems to be an article from Europe, possibly Germany. The

morbus bechterew mentioned is anklosing spondylitis (I googled it). Instead of

the words rheumatoid or idiopathic they use chronic in this article. Michele

Rheumatic Diseases in Children: Disease Patterns

Disease Patterns

http://home.t-online.de/home/rheuma-kinderklinik/rke-e002.htm

Many people think of " rheumatism " still as being a disease of adults or

seniors. That is not the case: For one thing, rheumatism is not a single

disease but a collective term for many different illnesses. In the other

hand unfortunately also children and adolescents contract the disease.

Besides there are a few rheumatic diseases which occur almost only in

children. The rheumatic diseases have in common that the immune system

does not work properly and begins to attack not only foreign matters

(e.g. viruses or bacteria) but also body's own tissue. Joint

inflammations can thus arise. Also impairments in tendons, muscles,

blood vessels and other organs can develop.

Below we shall give a short survey about the most important rheumatic

diseases of childhood and adolescence.

1. Transient synovitis of the hip (itis fugax)

The most frequent joint inflammation in children is called transient

synovitis of the hip. This inflammation of the hip joint involves

chiefly children between the 3rd and 10th year of life. They suddenly

start to limp, refuse to walk, and complain of pains. Transient

synovitis of the hip is generally painful, but resolves completely

without any lasting sequelae in most cases. But often at onset it is

difficult to isolate it from other partly severe diseases of the hip.

Therefore various examinations may be required before a certain

diagnosis can be set.

2. Reactive Arthritis

Many joint inflammations develop as a reaction of the body's own defense

mechanisms to previous infections with bacteria or viruses. Quite

frequently they may be observed after gastrointestinal infections with

diarrhea. They are named postinfectious or reactive arthritis or

sometimes acute rheumatism. Often swellings and warming of one or more

joints are seen. These illnesses can have a lengthy course and be quite

painful. Young children often report no pain at all. At a close look one

can sometimes observe in the beginning a change in movement or gait. In

most cases postinfectious arthritis heals completely and leaves no

permanent injuries in the joints.

3. Lyme-Arthritis

The Lyme-arthritis or borrelia induced arthritis is a special form of

joint inflammation. Lyme is the name of the place in Connecticut, USA,

where this type of arthritis has been first described. Borrelia are

bacteria transmitted by tick-bites and can cause various diseases, among

others also this joint inflammation. Here we often see pointed swellings

of single joints, quite often of the knee or ankles. In the blood and in

the joint fluid of the children and adolescents concerned various

antibodies against borrelia can be found. This identification is

important because borrelia-arthritis can effectively be treated with

antibiotics. There are, however, also cases in which the arthritis takes

a protracted course despite of sufficient antibiotic treatment. Then

there is the danger of lasting damage to the joints involved.

4. Juvenile chronic arthritis

The term juvenile chronic arthritis (JCA) refers to a group of joint

inflammations which are also called chronic rheumatism. Little is yet

known about its origin. But it seems certain that several factors are

involved in the development of these diseases. Hereditary

predispositions as well as previous infections, accidents (traumata),

and excessive stress may be of importance for the manifestation of JCA.

But often the disease starts without any known previous illnesses.

JCA lasts longer than the other forms of arthritis mentioned above. A

special danger of JCA consists of the fact that the inflammatory process

can impair the joints permanently if one does not succeed in halting it

as early as possible. This can result in lesions of the articular

cartilage and malpositions of the joints.

JCA is usually classified into various subgroups:

4.1 Systemic Juvenile Chronic Arthritis

The systemic juvenile chronic arthritis (SJCA) concerns about 10% of the

children with chronic arthritis. Often the onset is already in infant

age. High fever is apparent in the beginning, recurring over several

weeks, especially in the morning and afternoon, and does not respond to

antibiotics. A rash is partly seen, especially during the febrile

phases. Enlargement of liver and spleen is possible. Every 3rd to 4th

child incurs a pericarditis. An inflammation of the pleura and

peritoneum can join the condition.

At onset of disease fever as well as muscle and joint pain are often in

the fore without joint swellings. Later on these conditions mostly

retreat and an arthritis develops. In some children the arthritis

remains limited to few joints, often, however, are many large and small

joints involved.

4.2 Early Onset Oligoarthritis (Type I)

This form of JCA is also called " young girls' type " because it concerns

about 70-80% girls and only about 20-30% boys. Disease onset is usually

between the first and sixth year of life. As a rule only a few (up to 8

maximally) joints are affected. Knee joints and ankles are mostly

involved, but inflammation may also be found at elbow, hand and finger,

or toe joints. The distribution is mainly asymmetric, i.e. the joints

are not equally strong involved on both sides of the body.

An essential danger of the oligoarthritis type I is the chronic uveitis.

This is a matter of an eye inflammation causing no discomfort in the

beginning, however producing grave eye injuries if undetected. Therefore

especially patients with oligoarthritis type I must see the

ophthalmologist regularly!

4.3 Juvenile Polyarthritis

Polyarthritis means that there is an inflammation (arthritis) of many

(poly) joints. At least there are five joints affected, in most

patients, however, eight to ten or even more. While the pattern in

oligoarthritis is asymmetric, it is mostly symmetric in polyarthritis:

The joints of the body's right and left side are equally afflicted.

There may be an arthritis in large joints like shoulders, hips, or knees

as well as small ones like finger- or toe-joints. Often there is not

only an inflammation of the joints but of the tendon sheaths too.

Onset of disease can be at any age and concerns girls slightly more

often than boys. It means a considerable handicap for the children as

due to the disease they are greatly hampered in their natural urge for

motion.

The juvenile polyarthritis is also named seronegative polyarthritis as

the rheumatoid factor is not present in the serum.

4.4 Chronic Polyarthritis of the Adult Type

In contrast to the juvenile polyarthritis can the rheumatoid factor in

the adult type be identified. Therefore it is called seropositive

polyarthritis. It affects mostly girls from the 11th year of life on and

presents similar to the seronegative polyarthritis. However, the

finger-end joints are often spared. Beside the arthritis inflammations

of the blood vessels (vasculitis) can also develop.

Since the seropositive polyarthritis can progress rather fast and

produce damage on the joints if untreated, it is important to recognize

it early and treat it correctly.

4.5 Oligoarthritis Type II ( " Big Boys' Type " )

As the name " big boys' type " says mostly boys from school age on are

confronted with this form of arthritis. As in the oligoarthritis type I

mainly large joints are affected, the distribution pattern is asymmetric.

Mostly involved are knee- and ankle-joints, but also the hip joints or

joints of the upper extremity. Typical for the disease pattern is an

inflammation of the tendon appendages, so e.g. in the area of the heel,

beneath the patella or on the crista iliaca.

Also in the oligoarthritis type II eye inflammations can occur. This

acute uveitis presents itself, however, with pain, reddening and

shunning of light, so that it cannot be overlooked. With proper

treatment it heals quickly and resolves without any consequences.

If in addition an inflammation of the sacroiliacal joints develops one

does not speak of oligoarthritis type II but of juvenile spondarthritis.

From this at later age a Morbus Bechterew may turn up. If this happens

it might be after about the 20th year of life.

4.6 Psoriasis Arthritis

Psoriasis is a chronic skin disease. About one third of the patients

develop joint problems, many of them arthritis. While in adults usually

the skin symptoms appear first and the arthritis follows, we see in

children often the arthritis before distinct skin lesions lead to the

diagnosis psoriasis.

The psoriasis arthritis mostly proceeds like oligoarthritis and rather

benign, but can also spread to many joints. Typical is the involvement

of single fingers and toes.

4.7 Others

Chronic arthritis is also observed in inflammatory bowel disease like

Morbus Crohn and colitis ulcerosa. Inflammatory diseases of the

connective tissue may also be accompanied by arthritis.

5. Rheumatic Fever

Before antibiotic treatment was established, rheumatic fever was a quite

common disease. Nowadays it is hardly ever seen. Rheumatic fever follows

an infection with certain bacteria (streptococcus). It causes

inflammations in the joints and of the heart. In order to prevent

lasting heart injuries effectively an antibiotic treatment is indispensable.

Lately a rising number of patients with rheumatic fever was reported

from the USA. This statement, however, is not secured. In Western Europe

such observations have not been made.

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